Provider Demographics
NPI:1225062326
Name:DENTON, RONALD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:DENTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-2314
Mailing Address - Country:US
Mailing Address - Phone:260-463-2111
Mailing Address - Fax:260-463-7496
Practice Address - Street 1:612 S DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-2314
Practice Address - Country:US
Practice Address - Phone:260-463-2111
Practice Address - Fax:260-463-7496
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007103A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100159700Medicaid